Displaced point of maximal impulse
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
During a cardiac examination, the normal point of maximal impulse (PMI) should be routinely palpated in the left midclavicular line between the fourth and fifth ribs (normally 2-3 cm in diameter). The normal PMI represents the apical impulse of the left ventricle. A displaced PMI sheds light on abnormalities of the heart, and therefore allows for a correct diagnosis
Differential Diagnosis of a Displaced PMI
In alphabetical order [1]
- Aortic aneurysm
- Dilated pulmonary artery
- Left ventricular aneurysm
- Left ventricular enlargement
- Left ventricular hypertrophy
- Massive pleural effusion
- Right-sided tension pneumothorax
- Right ventricular dilation
- Right ventricular hypertrophy
Chest X Ray
- Chest X-ray is useful for the diagnosis of congestive heart failure, pneumothorax and pleural effusions
MRI and CT
- MRI and CT scan for patients with aortic dissections or aortic aneurysms
Echocardiography or Ultrasound
- Echocardiogram assesses the presence/absence of apical aneurysm, wall thickness, ventricular function, chamber size, measurement of pulmonary artery (PA) pressure (indirectly)
- Transesophageal echocardiogram (aortic dissections or aortic aneurysms)
Treatment
- Blood pressure control (left ventricular hypertrophy)
- Observation and diuretics (tension pneumothorax)
- Treatment of underlying etiology and diuretics (right heart failure)
Surgery and Device Based Therapy
- Needle decompression and chest tube (pleural effusions)
- Surgical correction (aortic aneurysm)
References
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:46 ISBN 140510368X